Spine surgeons debate the value of vertebroplasty and kyphoplasty

Orthopedics Today—New York, NY—October 30, 2009

Cement injection into acute or subacute vertebral compression fractures has increased in popularity in recent years. There are many anecdotal accounts of bedridden patients being able to walk off the procedure table following such injections. Prospective randomized studies, while hard to design properly and execute, are underway and beginning to be disseminated. Two recent studies in the New England Journal of Medicine have questioned the benefit of vertebroplasty and given reason to re-examine the appropriate indications, safety, and expected outcomes for these cement injection procedures.

A group of physicians from radiology, physiatry and spine surgery discussed these issues in a virtual Round Table format. A highlight follows:

Joseph M. Lane, MD, Hospital for Special Surgery: Both vertebroplasty (VP) and baloon kyphoplasty (BK) provide pain relief for vertebral fractures. In the literature the relief appears to be similar, but there has not been a large-scale randomized trial to define the relative advantages and disadvantages. Also, the literature notes a greater PMMA (polymethylmethacrylate) extrusion and there have been several acute deaths from VP secondary to cardiac/pulmonary compromise. In VP, the PMMA is more liquid and potentially can enter the vascular system easier carrying the PMMA and bone marrow products. However, with time, the physicians who use both BK and VP are well aware of the problems and think that both procedures are safe.